The Issue of Scar Tissue

Revision rhinoplasty makes up about 15 percent of all rhinoplasty surgeries. Patients usually seek out a revision rhinoplasty because a previous rhinoplasty did not yield the desired results or had unexpected complications.

What most patients don’t realize is that revision rhinoplasty is a more difficult procedure to perform than original rhinoplasty. There can be several reasons for this, such as patient anatomy or previous surgeon skill/technique, but one of the biggest is leftover scar tissue.

Why We Have Scar Tissue

Scar tissue forms after there is an injury to the soft tissue. Chances are you have a great deal of scars all over from accidents as a child or playing sports. You may even have surgical scars from something other than cosmetic surgery. When the skin is injured through a laceration or incision, fibroblast cells are brought in to repair the damage. The cells transport collagen and other important proteins that knit the skin back together and restore its function.

As the soft tissue heals, the scar tissue becomes noticeably different. It’s redder, thicker, and shinier than the undamaged soft tissue. Scarring varies from person to person depending on things like your skin’s elasticity and pigmentation, your age, and the extent of the damage caused by the injury. Over time, scar tissue fades to become white, but it never completely rejoins the original soft tissue.

Why Scars Are an Issue for Revision Rhinoplasty

Since scar tissue is formed during soft tissue healing, it is significantly stronger and tougher than undamaged soft tissue. It has to be in order for the skin to stay together while the tissue underneath the skin recovers. Scar tissue is also less flexible, which is an important characteristic of undamaged skin.

Scarring is a problem for any kind of surgery, but it is especially difficult in rhinoplasty. Rhinoplasty is performed in a small, very confined space, which means that there already isn’t a great quantity of tissue for the surgeon to work with. A surgeon performing revision rhinoplasty has to be able to navigate around or incorporate the leftover scar tissue so that the patient isn’t damaged even more by the surgery. If that skin isn’t particularly flexible, it can be hard for surgeons to reshape the inside or outside of the nose to be exactly what the patient wants. Patients who have had more than one previous rhinoplasty likely have a great deal of scar tissue leftover, particularly if the previous surgeon didn’t do a very good job.

What This Means for Patients

Not to worry, there are surgeons who are extremely capable and experienced at dealing with scar tissue during revision rhinoplasty. There are a few things that patients will need to keep in mind while looking into having the procedure:

You may not be able to get exactly what you want. A great surgeon will be able to get you as close as possible to your desired result, but they may not be able to completely accommodate the scar tissue. You should prepare yourself for the possibility that you won’t have the “perfect nose”.

That being said, there are surgeons who have the skills to do amazing work even with the presence of scar tissue. You need to do your research and remember that you get what you pay for. The more rhinoplasties you have, the more difficult it becomes with each surgery. Getting it right with your revision rhinoplasty is the best way to ensure that you will have good results.

During your consultation, be very clear about what you want. Bring in pictures of your ideal nose or take pictures of your own nose to demonstrate exactly what you’re looking for. The better you communicate with your surgeon, the more likely you will be satisfied with the surgery outcome.

Scheduling a Consultation

For the convenience of his patients, Dr. Naderi has two office locations, one in Herndon, VA, (703 481-0002) and the other in Chevy Chase, MD, (301 222-2020). Office hours are Monday through Friday from 8 a.m. to 5 p.m. The doctor can also be reached by email.